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The US is spending more money on healthcare than other developed countries, and getting poorer results for it. What could explain this paradox? In order to answer this question, we first need to understand what factors determine people's health. Healthcare, as in what doctors and hospitals and modern medicine provide, is only a small factor among many. Most of what is done in medicine is in response to sickness, not for the maintenance of health. In order to have a healthy society, and healthy people who live in it, we need more than just healthcare. This is a concept that has been lost to many in the profit-driven "healthcare" industry, and almost all politicians and policy makers.

Examine beneath the orange stethoscope to find out what those factors are.

What people need, in order to be happy and healthy, are autonomy, sense of purpose, economic security, and  food security. In order for people to lead a healthy lifestyle, they need education, starting from early childhood. In order to build a healthy immune system that is capable of fighting off disease during a person’s lifetime, they need proper nutrition during pre- and post-natal periods. Unfortunately, for the last 30 years, social thought and cultural vocabulary in American society have been transformed, such that it is now considered normal to deny those very things from vast portions of the public. <- highly recommended viewing!

Instead of investing in early childhood education, which would enable the next generation to live healthy lives, we are doing the opposite, and cutting such programs, which puts mothers at increased economic and health disadvantage. We are cutting food assistance to poor children, which makes them do poorly in school, and suffer from poor health. Instead of investing in a modern public transportation infrastructure, we insist on forcing people to drive cars, and spend endless hours commuting, leading to deleterious health effects. We claim to have a free society, and yet we house one fourth of all prison inmates on Earth. Instead of helping people suffering from poverty, we blame them for finding themselves under its yoke. It is not just lack of healthcare that is killing Americans; it is inequality. (Not only are the poor suffering, but the rich in America are actually less healthy too.)

I know I am preaching to the choir to say that all the talk about budget cuts, and why we can't afford to provide for the welfare of our children and the poor, is just hog wash, but just to emphasize the point, let's look at how the right social policies can improve social health outcomes. Chile is a country that emerged from a brutal dictatorship not too long ago. Its GDP is $256 billion, compared to the US with $17 trillion. Tell me who has more resources?



Healthcare cost per capita

Life expectancy at birth, both sexes

crude death rate









Obviously they're doing something right, which we're not: Universal healthcare coverage (pdf) with a mandated 7% tax; Universal Day Care; school feeding program; raising unemployment benefits instead of cutting them.  What do we do here in the US? We throw our kids' school lunches out, and let them go hungry. Social policy is the prime driver of social health, and it takes more than healthcare to be healthy.

Healthy people live in healthy societies. I fear that American society has lost its sense of togetherness, and we have become a band of automatons who are only forced to tolerate each other's proximity. Is it any wonder we are not getting our money’s worth out of our healthcare system? In order to improve the health of our society, and make our healthcare more cost-effective, we need more than just healthcare. In order to maximize their impact, physicians need to look beyond the prescription pad. They need to become advocates for social policies that promote health for the population at large. That would be not only good citizenship, but also good medicine.

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